Fellowship
 
Fellowship/ Observership Form

The Hospital offers Fellowship for Trauma & Reconstructive Surgery since 1994 to provide  experience in treating  difficult &  challenging trauma cases.
 
 Date of application :
 Name of the candidate :  
 Age :
 Sex :
 Email Id :    
 Birth date:  
 Address:  
 Telephone no. : -              
 Mobile No. :     
 Qualifications :
 Educational details :
Examination   Year of passing   Attempt Total marks Percentage Awards/
Distinction
 S.S.C.       %  
 H.S.C.       %  
 M.B.B.S.       %  
 Diploma %
 P.G. %
 Post P.G. %
Post held after post grduation :

(post held, duration, name of the hospital)
Research projects if any :
References
Name :  
Address :  
Father's / Guardian's name :  
Occupation :  




























































Site Designed and Developed by WEBPRO TEAM SYNERGEX INTERNATIONAL PVT LTD, Nagpur, INDIA